Reviewer response for version 2

Abstract

Editorial office note: The received date on the following peer review reports Reviewer 1 (https://doi.org/10.1099/acmi.0.000462.v2.3) and Reviewer 3 (https://doi.org/10.1099/acmi.0.000462.v2.1) have been edited to display correctly in the Review Status Breakdown box. These reports were received on 12 October 2022 and 27 September 2022 respectively. Fungal endocarditis is a rare and fatal condition, most frequently caused by the  Candida and Aspergillus species. Fever and changing heart murmur are the most common clinical manifestations. The diagnosis of fungal endocarditis is challenging, especially that of prosthetic valve endocarditis is extremely difficult. The optimal management of the condition still remains debatable. We hereby present a case of prosthetic valve endocarditis caused by Candida parapsilosis, managed empirically with liposomal amphotericin B and later on was shifted to combination therapy with high dose echinocandin and fluconazole, but had a fatal outcome because he could not undergo timely surgical intervention. Treating Candida parapsilosis endocarditis cases are difficult because of their ability of biofilm production on native and prosthetic heart valves. A combined approach consisting of high index of clinical suspicion, early diagnosis by using serological markers followed by culture or PCR and prompt initiation of appropriate antifungals may aid in improving the outcome.